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									                                                                            Fo o d Po v e r t y a n d H e a l t h
Food Poverty and Health

Briefing Statement


In the UK, the poorer people are, the worse their diet, and the more
diet-related diseases they suffer from. This is food poverty.1 Poor diet
is a risk factor for the UK’s major killers of cancer, coronary heart
disease (CHD) and diabetes. Yet it is only in the past few years that the
immense contribution it makes to poor health has been quantified:
poor diet is related to 30% of life years lost in early death and
Inequalities in people’s diets can result in inequalities in people’s
health. Those on low incomes suffer from poor diets, as evidenced by
lower fruit and vegetable intakes, and a higher prevalence of dental
caries among children. They are also disproportionately affected by the
major killer diseases. It is estimated that as many as 10 million people
in the UK live in poverty, including nearly three million children.2
Tackling food poverty is recognised as key to achieving government
targets on reducing inequalities and priority health areas including
cancer, CHD and older people and children. However, action needs to
be more than health professionals giving advice to individuals. It must
change the ‘food environment’ – that is, accessibility, affordability,
culture – in which people live. Public health professionals are ideally
placed to take the lead on this – through developing local strategies
and programmes to remove the barriers to healthy eating and thus
improve the nutrition of people living in food poverty.


The Department of Health (England) recognises food poverty as “the
inability to afford, or to have access to, food to make up a healthy
diet.” 3
                                                                                 Faculty of Public Health Briefing Statement

                                                                                           Food Poverty and Health             2

Food poverty and effects on health                         shift towards the recommended balanced diet. Key
Poor diet is a major health risk. It contributes to:       benefits include:

■   almost 50% of CHD deaths4                              ■   lowering cholesterol levels by just 10% in the UK
■   33% of all cancer deaths5                                  would prevent approximately 25,000 deaths
                                                               every year.10 This could easily be achieved
■   increased falls and fractures in older people6
                                                               through a reduction in saturated fat intakes
■   low birthweight and increased           childhood
                                                           ■   consuming fruit and vegetables has a strong
    morbidity and mortality7
                                                               protective effect against stroke11
■   increased dental caries in children.8
                                                           ■   reducing salt (sodium) intake decreases the risk
                                                               of hypertension (persistent high blood pressure)
There is also growing evidence to support the link
                                                               and therefore risks in cardiovascular diseases
between poor diets and anti-social behaviour. In a
                                                               such as CHD/stroke12
placebo-controlled study in men’s prison, vitamin,
                                                           ■   0.8mg of folic acid per day reduces serum
mineral and essential fatty acid supplements were
                                                               homocysteine by 3mmol, leading to a 16%
associated with a decrease of 37% in serious                   reduction in CHD and a 24% reduction in
incidents.9                                                    stroke13
A poor diet is characterised by excessive intakes of       ■   about 40% of endometrial cancer, and 10% of
saturated fat, salt or sugar, and an insufficient              breast and colon cancers would be avoided by
consumption of fruit and vegetable, and dietary                maintaining a healthy weight of a BMI of under
fibre.1                                                        25kg/m2 14
                                                           ■   increased dietary fibre is associated with a
Those who are most likely to experience food                   decreased risk of colorectal and pancreatic
poverty are:1                                                  cancer15
■   people living on low incomes or who are                ■   childhood fruit consumption may have a long
    unemployed                                                 term protective effect on cancer risk in adults.16
■   households with dependent children
                                                           The Nutrition and Food Poverty toolkit provides
■   older people
                                                           comprehensive advice on what constitutes a healthy
■   people with disabilities
■   members of black and minority ethnic
                                                           Food poverty and inequalities
                                                           Food poverty results primarily from inequalities, of
Modern Malnutrition
                                                           diet, diseases related to poor diet, socioeconomic
Diets high in fat, sugar and salt can result in
                                                           status, geographical region and ethnicity.
overweight and obesity – particularly when a
person’s intake from food and drink exceeds the
                                                           Inequalities in diet
energy they use. A poor diet which results in              ■ People on low incomes eat more processed foods
overweight/obesity      is  known     as   ‘modern            which are much higher in saturated fats and
malnutrition’. A significant proportion of the                salt.7 They also eat less variety of foods.17 This is
population is failing to meet current recommended             related to economies of scale and fear of
dietary requirements. For example, in England:1               potential waste.
                                                           ■   People living on state benefits eat less fruit and
■   children and adults eat 50% more saturated fat             vegetables, less fish and less high-fibre
    than the recommended level                                 breakfast cereals.18
■   children eat only one quarter, and adults only         ■   People in the UK living in households without an
    half the recommended levels of fruit and                   earner consume more total calories, and
    vegetables                                                 considerably more fat, salt and non-milk
■   children eat 50%       more    sugar    than     the       extrinsic sugars than those living in households
    recommended level.                                         with one or more earners.19

Modern malnutrition is more common in people from          Inequalities in diet-related diseases
lower socioeconomic groups.1                               Socioeconomic differences account for 5,000 deaths
                                                           a year in men aged under 65 years of age.7 In all age
The benefits of healthy eating                             groups, people living on a low income have higher
Significant health benefits can be achieved at both        rates of diet-related diseases than other people.
the population and individual level by enabling a
                                                                               Faculty of Public Health Briefing Statement

                                                                                         Food Poverty and Health             3

■   In men, 58% more manual workers die                  ■   Food labelling can be difficult to interpret and
    prematurely from CHD than non-manual                     even misleading, for example a fatty food which
    workers.20                                               claims to have no cholesterol is still a fatty food.
■   The prevalence of obesity among women in             ■   Food marketing – 99% of food and drink
    social class V is twice that of women in social          advertised to children during Saturday morning
    class I.21                                               children’s television programming were high in
■   Diabetes is one and a half times more likely to          fat or sugar or salt.
    develop in people in the most deprived 20% of
    the population compared with the general             Policy Context
                                                         There are a number of government health policies
■   Babies with fathers in social classes IV and V
    have a birthweight on average 130g lower than        designed to address the issue of food poverty, both
    babies with fathers in social classes I and II.7     directly and indirectly. The Nutrition and Food
■   In women, the premature death rate from CHD          Poverty Toolkit1 gives details of relevant policies and
    is more than double in manual workers,               strategies. However, key drivers include:
    compared with non-manual workers.23
                                                         UK: The Healthy Start scheme aims to improve
■   People from lower socioeconomic backgrounds
    are less likely to survive some cancers. For         nutrition, particularly for pregnant women, mothers
    example, the difference in breast cancer and         and young children, through making a wider choice
    colon cancer five-year survival rates between        of foods available, including fruit and vegetables.
    the most deprived and the most affluent are 7%       Healthy Living Centre Programmes target the most
    and 4% less, respectively.24
                                                         deprived areas and groups. They seek to address
                                                         the wider determinants of health including the social
Geographical inequalities
                                                         and economic aspects of deprivation such as social
There are significant regional variations in diet-
                                                         exclusion, and poor service access.
related disease in the UK. For example, there is a
steady rise in obesity rates in men, the further north   Sure Start is a UK-wide programme which aims to
they live.1                                              deliver the best possible start in life to children in
                                                         deprived communities. It offers opportunities for
Ethnicity                                                early interventions to prevent poor health in later
There are differences in diet-related disease in         life. Responsibility for delivering Sure Start in
different ethnic groups. For example, stroke             Scotland, Wales and Northern Ireland rests with the
mortality rates are around 50% higher in South           devolved administrations.
Asian and black Caribbean men and women than in
the general population.1                                 England and Wales: The 5 A DAY programme is part
                                                         of prevention strategies to reduce deaths from
Barriers to healthy eating                               cancer and CHD. It includes the School Fruit and
In order to eradicate inequalities in nutrition, the     Vegetable Scheme, and working with industry to
main barriers to eating healthily must be removed.       improve access to fruit and vegetables. Some
These include:1                                          aspects of the programme do not apply in Wales.

■   Low income and debt making healthier foods           England: Choosing a Better Diet: a Food and Health
    (which are generally more expensive) such as         Action Plan outlines government action to improve
    fresh fruit and vegetables, less affordable.         diet. It focuses on providing better information, and
■   Poor accessibility to affordable healthy foods       increased choice and access to healthier food. It also
    – linked to the closure of shops in deprived areas   aims to reduce the prevalence of diet-related
    (leading to increased cost, poor quality and         disease, obesity and improve the nutritional balance
    choice in remaining local shops), and to the
                                                         of the average diet. Choosing Health: Making
    development of out-of-town supermarkets which
                                                         Healthy Choices Easier is the overarching public
    may have poor public transport links.
                                                         health white paper which looks at the wider
■   Factors in food production and the food chain,
                                                         determinants and barriers to choosing a healthy
    such as the nutrient content of easily available,
                                                         lifestyle, including inequalities, physical activity etc.
    cheap, processed foods which can be high in fat,
    sugar or salt.                                       The Department of Health Public Service Agreement
■   Poor literacy and numeracy skills are barriers       (PSA) sets objectives to substantially reduce the
    to information on maintaining a healthy diet,        mortality rates from the major killer diseases as well as
    household     budget    management        and        halt the year-on-year rise in obesity among children.
                                                                               Faculty of Public Health Briefing Statement

                                                                                         Food Poverty and Health             4

Tackling Health Inequalities: A Programme for
Action sets out the government’s strategy to deliver      The Faculty of Public Health has produced, in
the PSA health inequalities targets, focusing on low-     association with the National Heart Forum, the
income and minority ethnic groups who are                 Government Office for the North West, the
disproportionately affected by the major diseases.        Government of the West Midlands and the West
                                                          Midlands Public Health Observatory, Nutrition and
Scotland: Eating for Health – Meeting the Challenge       Food Poverty. A toolkit for those involved in
integrates the Scottish Executive’s food policy and       developing or implementing a local nutrition
key partner strategies to promote healthy eating          and food poverty strategy.1 The toolkit is
and achieve Scottish Dietary Targets.                     designed to help professionals tackle food poverty
                                                          at local level. It outlines the barriers to healthy
The Scottish Community Diet Project seeks to
                                                          eating and the role poor diet plays in the major
improve Scotland’s diet and health through
                                                          killer diseases. Nutrition and Food Poverty forms
supporting low-income communities. It offers a
                                                          part of a wider campaign of work, in partnership
grant scheme for community initiatives to improve
                                                          with key health organisations, aimed at promoting
diet and health.
                                                          healthier lifestyles to reduce disease burden
                                                          through the production of toolkits on the wider
Wales: Food and Well Being – Reducing Inequalities
                                                          determinants of health including hypertension,
through a Nutrition Strategy for Wales outlines key
                                                          physical activity, obesity and fuel poverty.
actions to improve diet in Wales. Recommendations
include increasing fruit and vegetable intake, as well
as ensuring national and local policies are in place to   Recommendations
remove barriers to healthy eating.
The Community Food Initiative provides a limited          Improving nutrition and eradicating food poverty are
number of grants from the Welsh Assembly                  essential to national strategies concerned with
Government to increase healthy eating, particularly       tackling inequalities and healthy priorities, including
amongst the most disadvantaged groups.                    the major diseases of cancer, CHD and stroke.
                                                          Primary care organisations and local authorities, in
Northern Ireland: The Health Promoting Schools            association with other local organisations, should
Initiative envisages the school as a setting which        develop nutrition and food poverty strategies and
can offer considerable opportunities for tackling         programmes to reduce the barriers to healthy
inequalities in health and contribute to a child’s        eating.
whole development. The Fresh Fruit in Schools pilot
                                                          ■   Establish a local ‘food poverty partnership’ with
aims to provide access to fruit for P1 and P2 children
                                                              key organisations including health services, local
within pilot areas. It also aims to promote
                                                              authorities and voluntary organisations, for
awareness and uptake of healthy eating.                       example, to develop a local food poverty
Fit Futures: Focus on Food, Activity and Young                strategy. The Nutrition and Food Poverty Toolkit1
People is an initiative to develop ideas for improving        gives comprehensive advice on how to do this.
the health and well-being of children and young           ■   Work with local public sector service providers,
people through encouraging and supporting healthy             such as schools, hospitals, prisons etc, to
and active lifestyles.                                        develop procurement policies which ensure that
                                                              good quality, healthy food is sourced locally
Investing for Health is a framework for improving             wherever possible.
the health and well-being of people in Northern
                                                          ■   Work with the local community to understand
Ireland. It includes targets to reduce the gap in life        their views on priorities, barriers and
expectancy between the most affluent and the most             opportunities – through community meetings,
deprived communities.                                         surveys and promote healthy eating.
                                                          ■   Undertake a food mapping survey to identify
International: The First Action Plan for Food and             those shops where healthy food is affordable
Nutrition Policy. WHO European Region 2000-2005               and accessible.
focuses on the need to develop policies on nutrition      ■   Develop local programmes to promote healthy
that promote good health, and which contribute to             eating and physical activity. Initiatives such as
socioeconomic development as well as sustainable              cooking clubs, for example, should be created to
environments.                                                 encourage and develop cooking skills, and
                                                              increase nutritional knowledge. Integrate food
Details of policies and initiatives can be found in
                                                              poverty with existing local programmes and
Publications and Useful Organisations p.6.
                                                              strategies, such as local obesity strategies.
                                                                                   Faculty of Public Health Briefing Statement

                                                                                             Food Poverty and Health             5

   ■   Produce local information to explain the                    ● improving access to affordable, good quality
       importance of healthy diet and what constitutes               foods for those without cars, for example
       a healthy diet, as well as listing local suppliers            through improving public transport links and
       where good quality affordable food is available.              supporting shopping-carrying schemes, or
   ■   Work to eliminate the barriers to healthy eating              community delivery schemes from retailers.
       through:                                                      This can be considered in the planning and
                                                                     regeneration of town centres and residential
       ● providing help with money matters eg.                       areas
         through a local authority anti-poverty unit,              ● improving nutrition through schools, for
         and ensuring benefit entitlements are                       example by providing breakfast before
         claimed                                                     school, to help children who are not given
       ● providing better housing conditions to tackle               breakfast at home, and offering healthier
         lack of cooking equipment or storage to                     school meals.
         enable bulk buying

References                               7 Acheson D. 1998.                        evidence of causality from a
                                           Independent inquiry into                meta-analysis. BMJ; 325:
1 Press V on behalf of the                 inequalities in health. London:         1202-06
  National Heart Forum, Faculty            The Stationery Office
                                                                               14 Bianchi F, Kaaks R, Vainio H.
  of Public Health, Government
                                         8 James WPT et al. 1997. Socio-          2002. Overweight, obesity
  Office for the North West,
                                           economic determinants of               and cancer risk. The Lancet
  Government Office for the
                                           health: the contribution of            Oncology; 3(9): 565
  North East, and West Midlands
                                           nutrition to inequalities in
  Public Health Observatory.                                                   15 Department of Health. 1998.
                                           health. BMJ; 314: 1545-55
  2004. Nutrition and food                                                        Nutritional aspects of the
  poverty: a toolkit for those           9 Gesch CB et al. 2002.                  development of cancer: report
  involved in developing or                Influence of supplementary             of the working group on diet
  implementing a local nutrition           vitamins, minerals and                 and cancer of the Committee
  and food poverty strategy.               essential fatty acids on the           on the Medical Aspects of
  London: National Heart Forum             antisocial behaviour of young          Food and Nutrition Policy.
                                           adults. British Journal of             London: HMSO
2 National Statistics. 2005. First
                                           Psychiatry; 181:22-28
  release. Households below                                                    16 Maynard M et al. 2003. Fruit,
  average income statistics.             10 Unal B, Critchley JA, Capewell        vegetables and antioxidants
  London: Department for Work               S. 2004. Explaining the               in childhood and risk of adult
  and Pensions                              decline in coronary heart             cancer: the Boyd Orr cohort
                                            disease mortality in England          study. BMJ; 316: 499-50417
3 Department of Health. 2005.
                                            and Wales between 1981 and
  Choosing a better diet: a food                                               17 Dowler E, Calvert C. 1995.
                                            2000. Circulation 109: 1101-
  and health action plan.                                                         Nutrition and diet in lone
  London: Department of Health                                                    parent families in London.
                                         11 Ness AR, Powles JW. 1997.             London: Family Policy Studies
4 Yusuf S, Hawken S, Ounpuu S
                                            Fruit and vegetables, and             Centre
  et al. 2004. Effect of
                                            cardiovascular disease: a
  potentially modifiable risk                                                  18 Food Standards Agency. 2002.
                                            review. International Journal of
  factors associated with                                                         National Diet and Nutrition
                                            Epidemiology; 26(1): 1-13
  myocardial infarction in 52                                                     Survey: Adults Aged 16-64.
  countries (the INTERHEART              12 Maryon-Davis A, Press V on            Volume 1. London: Food
  study): case-control study.               behalf of the Faculty of Public       Standards Agency
  Lancet; 364: 937-52                       Health and National Heart
                                                                               19 Department for Environment,
                                            Forum. 2005. Easing the
5 Doll R, Peto R. 1981. The                                                       Food and Rural Affairs. 2001.
                                            pressure: tackling
  causes of cancer: quantitative                                                  National Food Survey 2000.
                                            hypertension. A toolkit for
  estimates of avoidable risks                                                    London: The Stationery Office
                                            developing a local strategy to
  in cancer in the United States
                                            tackle high blood pressure.        20 Peterson S, Rayner R. 2003.
  today. Journal of the National
                                            London: Faculty of Public             Coronary heart disease
  Cancer Institute; 66:1191-208
                                            Health                                statistics. British Heart
6 Vellas B et al. 1986.                                                           Foundation Statistics
                                         13 Wald DS, Law M, Mavis JK.
  Malnutrition and falls. The                                                     Database 2003. London:
                                            2002. Homocysteine and
  Lancet; 336: 1447                                                               British Heart Foundation
                                            cardiovascular disease:
                                                                            Faculty of Public Health Briefing Statement

                                                                                        Food Poverty and Health                6

21 Joint Health Surveys Unit.        Useful Organisations              Acknowledgments
   1999. Health Survey for
   England 1998. London: The         5 A DAY Programme                 Authors
   Stationery Office                 w:
                                                                       Modi Mwatsama
22 Department of Health. 2002.       British Dietetic Association      Food and Health Programme
   National Service Framework        w:                 Manager
   for Diabetes. London:                                               Heart of Mersey
   Department of Health              British Heart Foundation
                                     Heart information line:           Lindsey Stewart
23 Joint Health Surveys Unit.        08450 70 80 70                    Faculty of Public Health
   2003. Health Survey for           w:
   England 2001. London: The                                           Series Editor
   Stationery Office                 British Nutrition Foundation      Lindsey Stewart
24 Department of Health. 2000.                                         Produced by
   The NHS Cancer Plan. London:      Child Poverty Action Group        Faculty of Public Health
   Department of Health              w:                4 St Andrew’s Place
                                                                       London NW1 4LB
                                     Community Food Initiative
Publications                                                           t: 020 7935 3115
Choosing a Better Diet: a Food       Food Vision – Improving           w:
and Health Action Plan (2005)        Community Health and
Choosing Health: Making Healthy                                        Registered charity no: 263894
Choices Easier (2004)                                                  ISBN: 1-900273-20-9
                                     Joint resource from the Food
Public Service Agreement (2002)      Standards Agency, Local           Publication date: May 2005
Tackling Health Inequalities. A      Government Association, Local
Programme for Action (2003)          Authorities Coordinators of
                                                                       The information provided in this statement is correct

Department of Health                 Regulatory Services
                                                                       at the time of going to press.

w:                     w:          Design and print:

Eating for Health – Meeting the      Food Standards Agency
Challenge (2004)                     w:
Scottish Executive
w:               Fresh Fruit in Schools
                                     Healthy Promoting Schools
First Action Plan for Food and       Initiative
Nutrition Policy. WHO European       w: www.investingforhealthni
Region 2000-2005              
World Health Organisation                                              Summary
w:                  Healthy Living Centre
                                     Programmes                        This briefing gives an overview
Fit Futures: Focus on Food,          w:                 of the inequalities related to
Activity and Young People (2004)
Investing for Health                 Healthy Start                     food poverty, and its
w:   w:                  consequences including
                                                                       diet-related disease, as well as
Food and Well Being – Reducing       Local Government Association
                                     w:                 outlines the benefits and
Inequalities through a Nutrition
Strategy for Wales (2003)                                              barriers to eating healthily.
                                     National Consumer Council
Welsh Assembly Government                                              The statement also makes
Available from the Food Standards                                      important recommendations
Agency                               National Heart Forum              for action that can be
w:                   w:
                                                                       implemented at local level.
Investing for Health (2003)          Scottish Community Diet Project   It is not intended as an
Department of Health, Social         w:         exhaustive resource but as a
Services and Public Safety                                             signpost to the key evidence,
                                     Sure Start
                                     w:           publications and organisations
                                                                       as a next step to
                                     w:             understanding and tackling
                                                                       this important public health

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